Provider Demographics
NPI:1508299314
Name:EMERICK, KATRINA LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LYNN
Last Name:EMERICK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 SW 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5935
Mailing Address - Country:US
Mailing Address - Phone:845-551-4287
Mailing Address - Fax:
Practice Address - Street 1:5931 NW 173RD DR
Practice Address - Street 2:UNIT 10
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5106
Practice Address - Country:US
Practice Address - Phone:305-826-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist